Perimenopause marks a pivotal phase in a woman’s life, yet it often goes undiscussed, leaving many feeling unprepared. Understanding what is perimenopause, its stages, and what age perimenopause starts can provide clarity and confidence during this transition.

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What is perimenopause?

Perimenopause, often called the "menopause transition," refers to the years leading up to menopause. During this time, your body gradually shifts from its reproductive years toward menopause—the point when menstrual periods cease entirely. Estrogen and progesterone levels fluctuate significantly, leading to a range of physical and emotional symptoms.

This transition can last anywhere from two to ten years, with an average duration of about four years. Understanding what is perimenopause can help explain changes in menstrual cycles, mood, and overall health during this time.

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What age does perimenopause start?

One of the most common questions is: what age does perimenopause start? While every woman’s timeline is unique, perimenopause typically begins in the early to mid-40s. However, some may notice changes as early as their mid-30s.

The pre-menopausal age varies due to genetics, lifestyle factors, and overall health. Symptoms like irregular periods, mood swings, and sleep disturbances are often early indicators of perimenopause.

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Perimenopause stages

Perimenopause occurs in two distinct phases:

1. Early perimenopause
   

- Menstrual cycles become increasingly irregular, with cycle variations of seven or more days.

- Estrogen fluctuations begin, leading to symptoms such as sleep disturbances, mood changes, vaginal dryness, libido shifts, and brain fog.

- Many women may not immediately recognize this phase since symptoms can be subtle and intermittent.

2. Late perimenopause
   

- Periods become more sporadic, often skipping months at a time.

- Estrogen levels decline more significantly, leading to intensified symptoms like hot flashes, night sweats, vaginal dryness, and joint pain.

- Depression risk peaks, and fatigue becomes more chronic.

- This phase typically lasts 1-3 years before transitioning to menopause.

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Understanding the menopause journey

Perimenopause is just one phase of the menopause journey. Understanding the full scope of hormonal changes can help women prepare for the transition:

• Late reproductive phase: Fertility begins to decline, but menstrual cycles remain relatively regular.

• Perimenopause: Marked by irregular periods and fluctuating hormones. This phase can last between two to ten years.

• Menopause: Defined as 12 consecutive months without a period, marking the end of reproductive years.

• Post-menopause: Symptoms such as vaginal dryness and hot flashes may persist, but hormone levels stabilize.

The median duration of perimenopause is approximately four years, but symptoms can last longer for some women. The earlier symptoms appear, the longer they may persist.

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What’s happening in your body?

Perimenopause is a time of hormonal chaos. Understanding the monthly cycle can shed light on these changes:

1. First half (Menstrual & Follicular Phases): Estrogen rises as the body prepares for ovulation.

2. Second half (Luteal & Pre-Menstrual Phases): Estrogen and progesterone peak, then decline if pregnancy doesn’t occur.

3. During perimenopause: Hormone fluctuations become unpredictable, leading to common symptoms like mood swings, sleep disturbances, and changes in libido.

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Key changes to expect during perimenopause

While each woman’s experience is unique, common changes include:

1. Menstrual cycle irregularity: Periods may become shorter, longer, heavier, or lighter.

2. Hot flashes and night sweats: Sudden waves of heat or excessive sweating, especially at night.

3. Mood swings: Irritability, anxiety, or sadness due to hormonal fluctuations.

4. Sleep disturbances: Difficulty falling or staying asleep.

5. Vaginal and urinary changes: Vaginal dryness, painful sex, and increased urinary frequency.

6. Decreased fertility: Ovulation becomes less consistent.

Recognizing these changes can help you better manage perimenopause symptoms through lifestyle adjustments, hormone therapy, or other treatments.

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How to thrive during perimenopause

Navigating perimenopause doesn’t have to be overwhelming. Here are tips to help you thrive:

1. Maintain a healthy diet: Focus on calcium-rich foods, lean protein, and fresh produce to support bone and overall health.

2. Stay active: Regular exercise, particularly strength training, helps manage symptoms like mood swings and weight gain.

3. Prioritize sleep: Create a calming bedtime routine and practice good sleep hygiene to combat sleep disturbances.

4. Explore treatments: From hormone therapy to natural remedies, work with your Evernow provider to find solutions that suit your needs.

5. Build a support system: You are not alone—connect with friends, family, or support groups.

Perimenopause is a natural phase that marks the beginning of a new chapter in life. By understanding what perimenopause is, the perimenopause stages, and what age perimenopause starts, you can better prepare for and embrace this transition. Whether you're just entering the pre-menopausal age or deep into the journey, knowledge and self-care are your best tools for navigating perimenopause with confidence and grace.

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